Madness Prevails

Nightmare difficulty is the hardest difficulty in the game. You must use everything you have to survive. If you're down to your last rose, make sure you use Hysteria to survive. Clockwork Bombs help distract enemies, and the Pepper Grinder will injure enemies from afar. It's best to play Nightmare Difficulty after your first play through. Start up a new game under New Game + to keep all weapons and health increases from the start.